Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover what caregivers should know about helping their loved ones safely keep track of their medications with Judith Boyko, MBA, MS, RN, who has served as  the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007.

Caregiving MetroWest: What is meant by the term “medication management”?
Boyko: Medication management is a term that outlines the responsibilities of someone who cares for an individual taking multiple medications.

Medications come in a variety of forms, including pills, capsules, drops, patches, medicated creams, inhalers and more. It is important for a family caregiver, or someone who is brought in for in-home assistance (like a visiting nurse), to keep track of the different medications someone is taking; the medication frequency and dosage; and ensure that all instructions for taking the medication are followed properly.

Other medication management responsibilities may include filling and refilling prescriptions; keeping in close contact with an individual’s physician, a pharmacist and other members of the health care team; and keeping medications in a safe place, at a proper temperature.

CGMW: Why is it so important to keep track of the medications you or a loved one you are caring for is taking?
Boyko: According to VHQC, a health quality consulting company, between 40 percent and 75 percent of older adults “do not take their medications at the right time or in the right amount because of complicating factors such as the number of medications prescribed and the number of providers seen for multiple health problems, as well as other physical and cognitive challenges.”

In the older adult population, VHQC goes on to say that “medication non-adherence accounts for 26% of hospital admissions, almost 25% of nursing home admissions and 20% of preventable adverse drug events in community settings.”

Other side effects of mismanaged medication can include insomnia, loss of appetite, muscle weakness, confusion, depression and more.

Also imperative is to ensure that no food or beverages, including alcohol, will cause an individual to have an adverse reaction to a medication. For instance, statin drugs should not be taken with grapefruit or grapefruit juice. Some medications need to be taken with food; others on an empty stomach. And, multiple medications may contribute to food and drug interactions.

It is important to keep track of any adverse reactions from medications. For example, an anti-inflammatory drug may increase one’s risk for liver damage or stomach bleeding. An antihistamine may cause someone to experience increased drowsiness. Caregivers need to be knowledgeable regarding possible side effects of drugs that their loved one is taking; and note and report side effects to the patient’s physician or other health care provider.

Additional responsibilities when managing a loved one’s medication include understanding the prescription and reconciling the medication.

The United Hospital Fund’s Medication Management: A Family Caregiver’s Guide outlines the common codes used in prescriptions:

•    “Sig – You’ll see this on all prescriptions; it stands for “write.” It just means that the doctor is telling the pharmacist what to prepare and how to label the pill bottle (or other container).
•    Bid – Take this medication twice a day.
•    Tid – Take this medication three times a day.
•    Qid – Take this medication four times a day.
•    Q 3 h – Take this medication every three hours.
•    Qd – Take this medication every day.
•    Prn – Take this medication as needed.
•    Po – Take this medication by mouth”

Medication reconciliation, according to the Centers for Medicare & Medicaid Services, is “the process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider.” It also involves discussions about the medications with an individual’s doctor.

CGMW: What are some effective strategies for keeping track of medications you or a loved one you are caring for is taking?
Boyko: There are several.

•    My Medicine Record is a document available from the US Department of Health & Human Services. It’s an easy-to-use chart that requires the user or caregiver to add information about each medication, including the medication name, dosage, what it looks like, when and how to use it, and more.
•    A pill box with dividers can also be helpful. Medications can be placed in each “day” for easy patient access. Some even have timers that can be set to remind a patient that it’s time to take a certain medication. (An alarm clock can also notify a patient about medication time.)

Some hints:

•    Always keep one pill in the original pharmacy bottle to use as a reference.
•    Keep track of expiration dates on all prescribed medications
•    If a medication must be taken with food, place the pill box in the kitchen so it’s there during mealtimes.
•    Keep the medications that each person in the household is taking in separate locations. This will minimize confusion as to whose medication is whose.

Also, there are a number of questions to ask a loved one’s physician to ensure that a caregiver is managing medication properly. Such questions include: the medication name; why a loved one has to take the medication; if there are certain food, drinks or activities to avoid while taking the medication; whether or not a generic version of the brand name medicine is available; and whether or not the medication is covered under insurance, to name a few. Other questions can address missed or improper doses and side effects.

CGMW: Are there products or new technology that can help you manage your medications?
Boyko: We talked about basic pill boxes that may have dividers for each day of the week or month as well as those with timers. But there are other kinds of pill boxes that can serve as helpful tools for medication management, including those that automatically dispense a medication when it’s time to take it. There are also medication reminder watches and pagers – and even voice command medication managers.

Philips’ Medication Dispensing Service can help older adults manage their medication schedule, thereby reducing the risk of a medication error that can result in a visit to the hospital. The service provides caregivers with the peace of mind in knowing that their loved one is properly taking their medications without having to worry about being physically present to oversee their loved one.

CGMW: How do you help someone with memory or cognitive problems manage their medications?
Boyko: There are medication dispensers on the market that are geared specifically toward people with cognitive impairments like dementia. They have locks, alarms that can be set at different intervals, individual compartments and even a flashing light that is set off when medications aren’t taken at the appropriate time. They also can be set up to call an emergency number if an individual misses a dose. Other dispensers can even communicate with an individual’s caregiver to alert them that the medicine was dispensed to their loved one.

There are also home-based services like the ones we offer through Distinguished Care Options, by which a home health aide can visit an individual and remind them to take their medications. For caregivers working full-time, managing a family of their own or for those who live far away, hiring a professional to help with medication management can bring comfort. Home health aides can also support an individual with activities of daily living, such as meal preparation and exercise, as well as check vital signs and more.

CGMW: How important is it to communicate with your doctor(s) and pharmacist?
Boyko: Many older adults take medication for a variety of ailments. When treating “comorbidities” (more than one illness) with medication, it is important to understand how the medications will work and how taking multiple medications will affect the individual.

A doctor or pharmacist will be able to identify any side effects that a particular medication might present as well as any interactions it might have with other medications. For example, a doctor or pharmacist can recommend a schedule for taking multiple medications each day. They can also talk to a patient or caregiver about what may happen if a dose is missed or how the medication will make the patient feel.  And, the doctor can explain how to safely discontinue certain medications. Medication dosages should not be altered without consulting the patient’s physician.

A pharmacist will also be able to advise a patient or caregiver about alternative ways to take a particular medication. For instance, if a patient has difficulty swallowing pills, the pharmacist may be able to offer an alternative to the pill or a liquid form of the medicine.

CGMW: What is a “Brown Bag Checkup”? When should you have one?
Boyko: A “Brown Bag Checkup” is a wonderful way for people who are taking multiple medications to ensure the medications won’t cause issues like the ones mentioned earlier. It can also be an opportunity for a primary care physician to make adjustments to the medication regimen based on the patient’s changing health.

And it’s simple: just gather all of the medications you or a loved one is taking – including natural supplements, vitamins, minerals and over-the-counter (OTC) drugs, and bring them to your pharmacy or doctor’s office. A brown bag checkup can reduce the risk of adverse reactions; be an opportunity to identify outdated medications or duplicates; and can be a wonderful opportunity for a patient or caregiver to ask questions about the medications.

Judith Boyko can be reached at infonvna@natickvna.org. For additional information, visit www.centuryhealth.org, www.dco-ma.com or www.natickvna.org or call (508) 651-1786.